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Updates on Baby changes from Paedatrician Dr Chitti and Dr Lang

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I've got Anthony and Paul, he from Adelaide pediatrics, two fabulous pediatricians that are here to go through some of the week one challenges changes, newborn questions that will hopefully make you feel a lot more confident. But I thought before we got into that we might just know a little bit more behind the pediatrician and find out why you started. Why did you choose pediatrics out of all of the choices that you had in medical school? I sat with you Paul. Okay. For my juniors, Dr. days, I just loved working with children.

Yeah. And find them to be so you know, incredibly unique. And there's so much to learn about them this mystery, but there's, you know, all this creativity and that sort of thing and joy just bubbling up but at the same time, some real challenges, obviously. And I've got three kids of mine and love kids and I love seeing them reach their full potential and thriving in the context of whatever family they're in. It's, it's a great space to work in and to support people and, and to see real change. Wow.

And you obviously don't like sleeping either. I continue to live and I have these little babies, they come at different times. Wow. It's harder for families, though than it is. for us. Yeah, jacking off and coming back and taking off.

So amazing. What about us? like Paul said, I think you I think all pediatricians do love being around kids, and we probably all be kids ourselves. But for me, I was really lucky. I really had the best childhood imaginable. I really did.

Not just perfect parents, but four siblings, always someone to play soccer with or cometary within. By the impossible. I feel guilty that I was so lucky enough to have such a great job. And I knew that just such a great springboard for anything I did in life. And I just go to try to give something back and just try to help kids have the best childhood possible if it's just a small little thing I could offer to make that better to just hope them achieve anything if they've got a great childhood. Wow.

And Anthony, certainly a very good pediatrician. So he's done very well that is achieving his aims in life. I get the pleasure of looking after lots of his babies and lots of very happy parents that feel very reassured from the support that they get. But lots of mums. You know, first time moms especially have never heard of a pediatrician, or they've watched American shows, and they're always calling the pediatrician, like a GP, but in Australia, a pediatrician is more of a specialist. True.

Yeah, that is true. I mean, we're lucky in Australia that we've got great general practitioners who can do a lot of the stuff for children. But I guess it comes a time where whether it's the general practitioners, the patient's themselves feel as though they need a medical specialist for children. So, we are specifically trained just in kids, it's usually at least an extra seven years of Pediatrics that we do on top of the usual medical school program. And we deal with medical specialists that deal with diseases and illnesses in children that, that affect the health growth and development from from babies, children and once until they start union happy that they're on their own. So is there an age limit that a pediatrician would see a child right from the first minute of life?

Yeah, but you know, from the first breath, right up to virtually 18 years of age, essentially. So it's very broad and yeah, it's great that because you're gonna have a baby coming in with some challenges with fading or reflux or whatever, and then the next patient might be 12, and having some learning difficulties. By the problems, so, epilepsy, asthma, whatever, it's really varied. So that's what part of what makes it fun and challenging all at the same time. And it's one of the rewards is being with the family from the beginning and seeing them through to school or whatever. And it's really nice to see that family growth, especially if you've had siblings as well.

And that as well as being involved with three, four, sometimes five, I think it's pretty critical to see the whole family grow. Yeah, yeah. And the cars grow as well. Yeah. Yes, the cars get bigger, all of a sudden, the waiting rooms full and it's just one family. I must say that's one of the benefits that I've had over the years of being a midwife is that I've been able to see many families, you know, they keep coming back, especially in their childbearing years.

And you do it's that relationship and, you know, even though, you know, well for me, you know, the first time you're teaching them about what's normal, the second time you're teaching them how to adapt Because all of a sudden his two children, not just one, and then all of a sudden, you know, three kids, you're talking about budgeting and time management and, and all kids are different. Yes. their child is just blown away by how much that baby then younger turn really down just lucky with a birth. Nothing wrong with that dude. I know it's just a different personality than what they got the first time some people find it to be the most challenging. And it's important to say that it is I think the third child has to be noisy, so it never gets left behind anyway, because the other two are bigger.

Wow. Well, it's certainly you know, an enormous amount of knowledge that you guys have had. I've got for that whole 18 years, but we're just talking about that first little week. When these you know, typically first time moms will be bringing home a little baby. And you know, they've left hospital and I thought, Oh, how much weight did I say the baby's meant to put on and so you You know, the concept of weight loss with a newborn is new, you know, no one really talks about until you're in hospital. They're like, Oh, yes.

So the babies lost 300 grams. And you like, What? Why did it lose it? And you know, if they haven't had some great best breastfeeding education, they didn't realize that we're meant to lose weight. And, you know, sometimes all that information as they're walking out the door, they've forgotten, you know, how much how long should they take before they put that weight on? And, you know, what's the average weight loss weight gain?

Once they're back to birth weight? Go for Yeah. Oh, thanks, john. I would I mean, I, I think we probably recommend fairly similar things. And generally, I'd recommend, you know, baby's feeding at least six times in 24 hours, yes, when they go home. And a couple of ways in the first three weeks after leaving hospital, we'd expect the baby to put on a minimum of 150 grams per week.

In really in the first over that first three months period. just continually just ticking So that white game, you know that they needed to get back to birth, why is there a timeframe that you tend to work in, you should take about seven to 10 days so that most babies would lose weight, especially the first three or four days until mom's milk starts coming in. We generally would say, it would be unlikely to lose more than 10% of births still happens but that's when we start intervening. Mom's a bit more with the feeds you start expressing and things that we want to do, but by seven to 10 days, probably getting back to birth, and by two weeks there should be about six weeks as posted and for that 150 grams a week. And by six weeks it probably grown into the grams on average, which you think God six weeks I'd like to lose the kilos that for them to put on that one kilos, you know, for a little three and a half kilo Baby, you know, for them to be four and a half kilos is quite a different little person.

Absolutely. And you know, and it does just slowly come On, which is very exciting. So they're back to birth weight, hopefully by that day seven to 10 and putting on about 150 grams a week. But often babies also have jaundice, which is that, you know, that kind of yellowy tinge to their skin, which again, you know, is a bit of a shock for many new parents and they often go home with jaundice and think, what how long should that hang around for and why? I like to think of jaundice said divide into two certain physiological and pathological So what I mean by that is, is normal hair and the joints it's not normal. So, babies might go a bit jaundiced because quite often and livers not quite working as quickly as it should be.

It just takes a little while to to kick into gear. There are some other reasons why babies would normally go a bit yellow like the breaking down a lot of the red blood cells. Sometimes I can go to Georgia, and we do need to stop or therapy, shine lights on them. And in comparison pathological causes such as mom having a different blood group to baby and other other problems such as G six p deficiency, there are other things and it's up to the pediatrician to work. So, I normally tell moms on discharge if the baby's not looking to yellow to, to just remind them that the baby's looking for joy This is not to help out they speak to you, Milan is a 24 hour helpline number in Australia it is wise to speak to your local GP and and let us know to think about he's looking more to us because it can be dangerous.

But normally would it be you know, that yellow tinge would have gone by you know, the same time that they've acted both way would you say roughly that's right and usually the yellowness, the degree of illness peaks sometime towards the end of the first week. Yeah. And then starts to diminish after that. So yeah, often by seven to 10 days the jaundice coloring is going and it goes from here upwards so the face is the last to clear up jelly and the little whites of their eyes as part of that. That's right. Some babies however do stay jaundice for a number of weeks, okay?

Particularly breastfed babies, just very slightly jaundice. And that's generally not a dangerous form of jaundice without a baby still looking yellow at two weeks of age or beyond. That baby should be checked out just to make sure that there's nothing else other rare causes of jaundice going for a longer duration than two weeks, but often it is just breast milk jaundice, and that's a completely safe thing. Generally, there is something called biliary atresia, which is like a blockage of the liver. It's quite important that is picked up. Yes, six weeks.

Yeah. So that's why we are quite fussy when it does come to that don't just think all dogs is normal because sometimes it's And so if someone wasn't lucky enough to have such fine pediatricians as YouTube, and they had maybe just seen a pediatrician and briefly in and maybe a larger public hospital, would a GP be a great person to be worried about that? Absolutely. Excellent. Right. And you know, we know that GPS, we've got great knowledge and great referrals tools as well.

They feel that they've got nothing to worry about it. Excellent. Well, so port doubt. They don't look like a Jasper anymore. And they're shitting all of this skin rash that's coming on underneath, which is an interesting, you know, an interesting change many new parents who think their skins fallen often, you know, that, you know, two very important physiological changes. And maybe, Paul to explain to us.

Yeah, sure. Well, I mean, babies come out of this beautiful environment in the womb, where the skin comes out. so beautifully presented as being looked after by the vernix. It's incredible moisturizer, and then they're born and into a very different environment. And even in the first few days, often babies get quite dry skin, especially on their hand speed on the tummy. And moisturizer, just something gentle is great to put on there, even up to a couple of times a day.

And generally not using any soap in the bath can be helpful as well. skin rashes are quite common to and certainly in the first week of life, like it can look quite alarming. There's a condition called what's called toxic erythema, which is probably more than alarming there needs to be because it's very safe, but it's red blotches with a central sort of pile on slightly yellowish dot. They look like pimples visually, and some babies get loads of them. And they really stuffed up your photos and amazing how many parents think it's from the flowers? Yes.

I had a lady that saw that there was bid mites That's not true. But that particular edge, that little one that looks like pimples is very safe. And otherwise just resolves on a time doesn't need any special treatment. Yes. And then over the sort of the shooting, shooting few weeks, some babies even start to develop some dermatitis, or dry red, scaly rash, particularly, you know, around the face or on the top of the chest or new crash, which is more of a dirty read. Yeah, rash, which can come and go very much in the first three months or so of life.

And they, you know, you don't need to rush off for special creams and potions. That's right, I think if you buy these otherwise completely well, and it fits one of these very common patterns. Yes, no, it doesn't need any special treatment generally. pretty rare for a baby not to have some sort of rashes. Yeah, absolutely. Very rarely two babies have that beautiful baby.

Yeah. They usually are a bit rash. And see six weeks is also when the significant driver started. Am I pausing moisturizing is the case. Brush can be another common issue chubby babies lift their arms or in the coin creases. In other cases, they get a smelling rash.

And that can have a crush that's want to sometimes just walk over here just cleaning baby trying, baby. Yeah, and I certainly really fight you when you're making sure you're getting all those moist areas. So sometimes when I do show parents and you lift up that neck and the throat, especially the chubby baby reflex to you know, get sits down in the creases, it's awesome. It can really smell. So, nappy rash is another thing too, which is quite common. And in particular, zinc based berry crank can be very good for the sort of red moist rash around the around the ionosphere.

And even for the moist stuff up in the creases up here, sometimes the zinc price barrier can be quite good sort of barrier protection is to stop that view considerably. There's nothing fancy about this in crime, it just stops that went away. Yeah, actually the nappy area or the saliva from rotating the skin, just that bit of a barrier on the skin. Yes. Very good. And you know, I guess at the end of the day, all of these rashes are really normal.

And, you know, in life, you know, we get a pimple and we want to crane to put on it to make it go away. I think it's quite a different mindset. The new parents, when there is a rash they think, well, I need to fix it and I mean, you know, what's the cream I can put on it to make it go away? And I guess, you know, to read, reassure that a lot of these normal rashes are normal when they're kind of a change from within as well. I think also just remembering if there was a rash that you think isn't quite right and smelly, looks infected red babies unwell, has a fever, not feeling well then it could be significant. exclusion, yes.

And to get that that little baby reviewed, and that's a perfect leading on To the unwell baby, and you know, these new parents, they've only had this baby for a week. It's really hard to tell what's what's unwell and what's, you know, something to worry about what not to worry about. And obviously, there's these new bane of my life, those fancy thermometers that go across the forehead, that gives you a adjusted temperature. So, you know, I guess, what are the real signs of it if they aren't? Well, like you said, So, some parents might ask, what what is a normal temperature tie normally would be less than 37 to 37 and a half. So if a baby's temperature is 37, and a half or more species, they could very well be erasing it for that.

Individual on board that baby isn't feeling well. Significant vomiting out of the ordinary, or just not quite right trusting instincts. He sticks a sign that something's wrong. It could be one of the first questions that any health professional would ask would be. Does your baby have a temperature sensor? It is important to have a temperature.

Yes, that's a good. Good. Yes. And you know as the thermometers in the hits monitors meander on some monitors, I guess this is my opinion. It's all about opinions. But I find that under the answer woman this would probably be the most accurate with little babies that humans can't fit in very well.

That's right. Isn't digital thermometers? Good under the arm the perfect I think and then I tend to take too long to know. They're only two seconds. Yeah, that's the other thing to remember too is that some babies will be significantly unwell, but may not always have a fever. Yeah.

Apart from the temperature go also by having your babies behaving as Anthony was saying. So if your baby's not feeding Well, it's a very irritable Yes. With or without a fever, that might be significant. And if you are really concerned, our general advice is always to go to a larger Metropolitan hospital with a small, small baby like GPS that the GP clinics really aren't equipped to assess or, or to treat a little baby like this if you do have a very sick child, but if you're not sure if the child doesn't have to bear their GP is your first port of call is absolutely fine. Yeah, but you're right. If if there was a quantity charged, yes, go straight to one of the modules.

Yeah. So and the as Anthony said earlier, the health direct line or the line that's on the back of all of your child health books is really great. Even if you just need someone to chat to you. They're a really good resource to get all that information. Excellent. reflux.

My first time was a reflexes so I I learned so much more than what I'd ever read in the textbook. Yeah. First Express reckon he was a real speaker and he was really unsettled. And let's face it, a lot of babies vomit, you know, tight from various from tiny spills to sort of moderate reflux where it might sort of come out and, you know, all crusty over your lovely new couch. So and it's a matter of saying what's what's normal, what's happening. And most babies who vomit sort of small to mild amount to otherwise completely happy, growing will, they're not vomiting anything up on that looks unusual, like green ball, bladder, coffee ground bits, but it's just milking or watering.

It growing really well. It's not excessive vomiting and they're happy, then it's probably just what we call uncomplicated simple reflux, and might not need any treatment. Or just some simple things like setting your baby up between sides, breastfeeding and after foods. As well, just to allow things to go down with gravity to help that help out. And thickness can occasionally be helpful. Particularly if you bought a bottle feeding it can be a lot easier and strain wanted to add that to the bottle there are some pre thickened formulas as well the IR versions, which can help out makes the milk thicker sound less likely to shoot out to come out along the Gulf.

But some babies do have complicated reflex. And yet so I guess we'll call it physiological rape. That's a normal reflex at the babies driving and still posted. And then sometimes quite rarely, actually you do we call it reflux disease. Where there are complications from the reflex like the baby stopping breathing, or planning to thrive, or any significant vomiting. Especially big vomits in the baby losing weight.

There's something called pyloric stenosis, which basically through the guts Usually your firstborn. Male baby. That's something to always think about. Usually by six weeks, you can spot those but yeah, cuz it's so skinny. Yeah, that's right. So, so vomiting can be a sign of something else.

But usually, if babies checking off a little bit, it's pretty well, it does improve. Yeah, it just means laundry. Do you think this little person how do you make so much laundry? They do. And you know, especially in this first week, when that little Tommy you know, six days ago only held two or three meals and all of a sudden, you know, it's having 5060 7080 meals, you know, there is quite a lot of that simple reflex where it's just, and it just, you know, have the baby out, right? And, you know, catch it if it comes out.

So, try not to get too complicated too early, really and call it Is the other major talking point with little babies the reflexing? Baby I had to college. Yeah, so nice was a shocker. And I did learn a lot going through that, and then take those don't really. And that's because there is nothing wrong with the babies with colleagues. So as medical specialists, and I think what what's important to know about about doctors is that we go by weights proven in studies, and there aren't a lot of studies on babies with colleagues.

So what is colic? If you look at the strict definition, it's a magnet cause more than three hours a day for more than three days a week that really weed it down. Just under two hours and 15 minutes? No, I think colic is if the baby's crying enough or it's a problem for the family, then that's probably significant. And I think it's a present in most babies. So studies might suggest 50% of babies, but I think it might even be a degree of collagen in most babies and wherever you go around the world.

It's president Every single time around the world, some people call it the witching hour period, particularly in the evening where babies are unsettled and they're not hungry. They're not tired. They just cranky. And it can be really tough. And suddenly he was, he was cranky. And and it was hard to go through that.

But realizing that okay, well, let's just work through this. Let's make sure there isn't anything going on. And usually there's not but you bear with us that you claim that there might be something wrong with the child and then have the moon viewed and I think that's the most important comic. So it usually takes between six and eight weeks. And then it gradually gets better and by 12 to 16 weeks it should be gone. Otherwise, it could very well be something going on something else underlying Yeah, yes.

Well, you have the reflex the baby, you had the colicky baby and I just had the cranky baby. So I know so much about sleeping. And six he still likes to climb into bed and you're like oh my god. So, you know, we tend to all get one of them are a mixture of all of these really normal changes. And you know, for a first month, you know, you get so much advice about Oh, it's really colicky, isn't it? Did you eat anything?

And you're like, no. So does it matter? Now all of those food intolerances that are assumed a link to you know, something that you've done to make your baby unhappy? Yes. Oh, that's really interesting, because, I mean, most obviously, most colicky babies, there's actually no medical cause, yeah, underlying medical issue going on. And they do settle in just with some settling techniques, and reassurance to the family that this is a normal thing and it will get better and here's some strategies for getting through those few hours in the evening.

Occasionally, somebody will be intolerant to, especially things like cow's milk protein, or other babies will be unsealed if they are unwell or have a hernia. That sort of thing. But mostly, the things that come through on the diet are just very transient causes or unrelated, unrelated Yeah. Yeah. So if a baby is quite unsettled, or like Paul said a dairy allergy might need exclusion, urinary urinary tract infection, yeah. Often if we're going to do anything, sometimes just a quick little check of the Uranus or we need to do a specialist sometimes just to double check that, but there can be other causes.

And I think just a good check of the baby a good detailed examination, and sometimes it's as simple as helping with that. Excellent. Yeah. Would you sleep if your skin was that red and itchy? Yeah, hopefully No, probably not really? Yeah.

Or if they've got that real, are all thrashed and they're just really irritated. I think I'm happy if I had a simple treatment reflex if that's thought to be an issue. Yes. So yes, there's lots of, you know, lots of, I guess, different reasons. And, you know, we don't expect you as the new parent to know those answers. don't know yet.

Collectively, you find young men have been around and specialists in this area for a very long time. And so that's why you would get, you know, a GP or a specialist opinion if you were feeling overwhelmed and you felt in your heart of hearts that there wasn't something quite right. So don't feel like you need all the answers. I get your face been around the block for a little while your kiddies are a little bit older now for these beautiful new parents at home. What piece of advice would you have for them? This first stage of parenthood.

My one piece of advice I think that I've tried to give to you parents is just enjoy it goes so quickly and I know it's easy to look. So as you're older to say that it is true that time goes so quickly. Enjoy those early moments. Don't stress about every drop of milk that is coming or not coming. The crying as hard as it is just trying to capture those moments with baby does smile back at you. It just goes to Quickly, don't try to do it on your own.

It's not natural to do it on your own. There is a time it takes a village to grow a child and I do believe that get help from professionals from family members. Don't try to do it all yourself this month to help out there is no such thing as a perfect parent. As long as you try, which is try if that's very true. Exactly. And I think it's sort of a crazy kind of wonderful the first few weeks Yeah, well what's happened you know, particularly if it's your first baby in life seems to have changed very significantly.

And I say to people look, it's really important to have a sense of humor because it's just completely unpredictable. What's going to happen this little person can change your life. So massively so have a have a sense of sense of humor. Don't put too much pressure on yourself to you know, maybe try and have everything perfect that usually would perhaps in the house when you have more time or whatever. Look after yourself. Look after you by me.

Everything else can wait but enjoy Get in and have a laugh when that baby doesn't massive poo on your white cup. Well, thank you. So we'll hear from these lovely guys a little bit later on in the course. Thanks very much

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